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Pharm test 3

Pharm adrenergic blocking agents ch.18

QuestionAnswer
Adrenergic blockers **adrenergic antagonists **sympatholytics bind to adrenergic receptors, but inhibit or block stimulation of the sympathetic nervous system (SNS) **alpha blockers and beta blockers
alpha blockers -cause both arterial & venous dilation, reducing peripheral vascular resistance & BP -used to treat HTN -effect on receptors on prostate gland & bladder decreased resistance to urinary outflow, thus reducing urinary obstruction & relieving effects of B
alpha blockers -alpha blocker like pills are used to treat HTN b/c it dilates -alpha is resp. for sphincter control so ppl with problems going to the bathroom take an alpha blocker (especially men over 60 w/ enlarged prostate -- BPH (benign prostate hypertrophy)
alpha blockers used to control & prevent HTN in patients with pheochromocytoma pheochromocytoma: tumor in adrenal gland. ppl w/ this have malignant HTN b/c they constantly secrete things coming form adrenal cortex (NE, EPI, adrenaline)
alpha blockers: phentolamine -quickly reverses the potent vasoconstrictive effects of extravasated vasopressors such as norepinephrine or epinephrine **restores blood flow & prevents tissue necrosis phentolamine: lets say I gave you too much epi in IV & it infiltrated, your blood vessels start constricting in arm so you have less blood supply to that area & that tissue can die **you can shoot in phentolamine subq causing vasodilation to save your ar
alpha blockers side effects CV: palpitations, orthostatic hypotension, tachycardia, edema, dysrythmias, chest pain CNS: drowsiness, dizziness, headache, anxiety, depression, vertigo, weakness, numbness, fatigue
alpha blockers side effects GI: nausea, vomiting, diarrhea, constipation, abdominal pain OTHER: incontinence, nosebleed, tinnitus, dry mouth, pharyngitis, rhinitis
Common alpha blocker agents -phentolamine (regitine): used to dilate if given a vasopressin -prazosin (minipress) -tolazoline (priscoline)
It is common to see the first dose faint effect when receiving alpha blocker agents First does faint effect: ppl. will get out of bed & faint b/c they re pretty powerful BP meds (can cause orthostatic hypotension)
what do alpha blockers usually end in? -zosin **they are pretty powerful in lowering BP
beta blockers -block stimulation of beta-receptors in the SNS -compete with norepinephrine and epinephrine -selective & non selective also called cardio selective & non specific
beta blockers they are very popular; they lower BP no b/c of vasodilation (if you block beta1 the HR will slow down & so cardiac output is going to decrease which decreases the BP)
Cardio selective and nonspecific cardioselective: selective b/c it only blocks beta1 in the heart nonspecific: blocks both beta 1 and 2 and it is nonselective
beta 2 blocker **beta 2 receptors primarily on smooth mucles of bronchioles & blood vessels if you block beta 2 it will constrict the bronchioles which would be a problem for asthma-- so in someone w/ asthma you would give them a cardioselective blocker so that you dont make asthma worse by constricting their bronchioles
non specific beta blockers **block both beta 1 and 2 -Propranolol (inderal) -labetalol (trandate, normodyne)
what do beta blockers end in? beta blockers end in -lol
cardioselective beta adrenergics -acebutolol (sectral) -atenolol (tenormin) -metoprolol (lopressor)
mechanism of action for cardioselective -slows down conduction rate -reduces SNS stimulation of the heart -decreases HR -prolongs SA node recovery -slows conduction through AV node -decreases myocardial contractility, thus decreasing myocardial oxygen demand
mechanism of action for cardioselective -patients with angina have chest pain b/c of need for O2 in the heart so you would give a beta blocker to reduce contractility which decreases oxygen demand in the heart
mechanism of action for nonspecific (beta1 & beta2) effects on heart: same as cardioselective bronchioles: constriction, resulting in narrowing of the airways & SOB blood vessels: vasoconstriction
Indications for beta blockers antiangina: decreases demand for myocardial oxygen cardioprotectve: inhibits stimulation from circulating catecholamines **studies have shown that if you had a heart attack & are given a beta blocker it prevents having a heart attack in the future
indications for beta blockers -antihypertensive -treatment of migraine headaches -glaucoma (topical use)
side effects of beta blockers -decreased force of contraction -decreased cardiac output -decreased BP -decreased HR -decreased automaticity of ectopic pacemakers -slowed conduction through AV node -less effective metabolism of glucose -less ability to respond to stress
side effects of beta blockers less ability to increase HR & cardiac output in response to exercise or activity **watch HR and hold drug if <60bpm (take pulse)
common adverse effects of beta blockers -bradycardia -congestive heart failure (CHF) -weakness, fatigue -bronchoconstriction **sometime you slow the HR so much that you get a weak heart (CHF) not pumping enough to perfuse major organs like kidney & brain so you start retaining fluid, BP
adrenergic-blocking agents implications -avoid OTC meds b/c they cause vasoconstriction and they can counteract -possible drug interactions with: antacids, antimuscarinics/anticholinergics, diuretics & CV drugs, neuromuscular blocking agents, oral hypoglycemic agents
NURSING IMPLICATIONS for adrenergic-blocking agents -teach patients to change positions slowly to prevent postural hypotension -avoid caffeine (excessive irritability) -avoid alcohol (can have a glass)
therapeutic effects for adrenergic-blocking agents -decreased chest pain in pt. with angina -return to normal BP and P
NURSING IMPLICATIONS for beta-blocking agents -rebound HTN or chest pain may occur if this medication is stopped abruptly -inform pt. that they may notice a decrease in tolerance for exercise; dizziness & fainting may occur with increased activity
you should NEVER abruptly stop a beta-blocker **if you choose not to take drug you can damage kindey or have a heart attack -sometimes men do b/c these drugs can cause erectile dysfuntction -the heart is pumping slowly & then you abruptly stop, this will cause the heart to start beating super fast & can cause heart attack
when taking beta blockers pt. should report weight gain of more than 2 pounds within a week -if you're gaining too much weight it is water weight and this can be indicative of congestive heart failure
A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma." VS: BP 126/84 pulse 62 resp. 24 1.Prop. blocks wut receptor blocks beta 1 and 2 which affects his asthma and decreases HR
A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma 2. could propranolol affect asthma? yes it does
A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma 3. what effect could propranolol have on HR. why? decrease HR
A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma 4. what are the teaching aspects that should be explained? do not abruptly stop, teach him how to take pulse & call doc if it is less than 50.
A 58 y/o male is taking propranolol (inderal) 40 mg TID for angina & cardiac dysrhythmias. During nursing assessment, the nurse records that the ct. state, "I am troubled at times with asthma 5. what could happen if ct. abruptly stopped this drug? if he abruptly stopped he can develop HTN & eventually have a heart attack
when a patient has experienced infiltration of a peripheral infusion of dopamine, the nurse knows that injecting the alpha-blocker phentolamine (regitine) will result in local vasodilation
when administering beta-blockers, the nurse knows that which guideline for administration and monitoring is correct? weaning off the medication is necessary to prevent rebound HTN
The nurse providing teaching for a pt. who has a new perscription for beta1 blockers will keep in mind that these drugs may result in which effect? bradycardia
a patient who has recently had an MI has started therapy with a beta blocker. the nurse explains that the main purpose of the beta blocker is to protect the heart from circulating catecholamines
before initiating therapy with a nonselective beta blocker, the nurse should assess the patient for the presence of asthma
a patient is taking an alpha blocker as treatment for benign prostatic hypertrophy. the nurse monitors for which potential drug effects? -orthostatic hypotension -increased urine flow -headaches
Created by: lissy11